Unno Naoki, Yamamoto Naoto, Higashiura Wataru, Suzuki Minoru, Mano Yuuki, Sano Masaki, Saito Takaaki, Sugisawa Ryota, Konno Hiroyuki
Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Ann Vasc Dis. 2013;6(3):642-50. doi: 10.3400/avd.cr.13-00047. Epub 2013 Sep 5.
Fenestrated endovascular abdominal aneurysm repair (FEVAR) using branched arteries devices for visceral arteries is increasingly being used for the repair of juxtarenal aortic aneurysms (JAAs) in Europe, United States, Australia, New Zealand, and Asia. This study aimed to evaluate the technical feasibility and short-term results of FEVAR in treating JAAs in Japanese patients.
FEVAR with Cook fenestrated stent-graft (Cook Medical Inc., Bloomington, Indiana, USA) was performed for 5 patients at high risk for open repair of JAA. Seventeen visceral vessels were successfully accommodated with 12 fenestrations, and five visceral arteries with four scallops with a loss of renal artery. In one case, a type III endoleak occurred at a renal artery fenestration, and this had disappeared in the 1-month postoperative computed tomography (CT). The mean follow-up duration was 8 months. Iliac leg occlusion occurred in 1 case, which was treated with thrombectomy and additional leg device deployment. All patients had survived at the end of the follow-up period and continued their outpatient visits.
Implantation of a Cook fenestrated stent-graft incorporating the visceral arteries is technically feasible in high-risk Japanese patients with JAA and may be a viable alternative to current methods.
在欧洲、美国、澳大利亚、新西兰和亚洲，使用用于内脏动脉的分支动脉装置进行开窗式血管内腹主动脉瘤修复术（FEVAR）越来越多地用于治疗近肾主动脉瘤（JAA）。本研究旨在评估FEVAR治疗日本患者JAA的技术可行性和短期结果。
对5例JAA开放修复术高危患者进行了使用库克开窗支架移植物（美国印第安纳州布卢明顿市库克医疗公司）的FEVAR。17条内脏血管成功通过12个开窗以及5条内脏动脉通过4个扇贝形开窗得到处理，其中1条肾动脉未被覆盖。1例患者在肾动脉开窗处出现III型内漏，术后1个月的计算机断层扫描（CT）显示内漏消失。平均随访时间为8个月。1例出现髂支闭塞，经血栓切除术和额外的髂支装置置入治疗。随访结束时所有患者均存活并继续门诊随访。
对于日本JAA高危患者，植入包含内脏动脉的库克开窗支架移植物在技术上是可行的，可能是当前方法的一种可行替代方案。
